Exam 14: Breasts and Regional Lymphatics

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Four groups of axillary nodes drain 75% of the lymph from the breast. The groups are the central axillary nodes, high in the middle of the axilla; the pectoral (anterior) nodes, along the lateral edge of the pectoralis major muscle; the subscapular (posterior) nodes, along the lateral edge of the scapula; and the lateral nodes, along the humerus, inside the upper arm. A small amount of lymph flows up from the central axillary nodes to the infraclavicular and supraclavicular nodes.

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An early sign of pregnancy for most women consists of breast changes that begin during the second month. Pregnancy stimulates the expansion of the ductal system and supporting fatty tissue and development of the true secretory alveoli. The breasts enlarge and feel more nodular; the nipples are larger, darker, and more erectile. The areolae enlarge and become a darker brown, and the tubercles become more prominent. A venous pattern is prominent over the skin surface. Colostrum may be expressed after the fourth month.

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Breast-self examination (BSE) should be taught after the assessment is completed. Do not distract from the examination to try to teach at the same time. Help each woman establish a regular schedule of self-care. BSE is best done right after the menstrual cycle, when the breasts are the smallest and least congested. For women who are not having menstrual periods, a familiar date should be chosen to examine her breasts each month. In addition, review the American Cancer Society's recommendations for mammograms and clinical breast examinations. Last, the text describes a new breast cancer screening tool that helps to identify and calculate an individual's risk for breast cancer.